tv University of Southern California Hosts Discussion on Prescription Drug... CSPAN April 14, 2017 10:15am-11:30am EDT
the rise of prescription drug addiction in the united states. panelists at this program include a doctor, a health economist who advises the congressional budget office, and the makers of two documentary films that examine the relationships between the fda, political leaders, pharmaceutical companies, doctors, and the media. 15s is about one hour and minutes.
>> ladies and gentlemen, welcome to tonight's event at the university of southern california. please take a moment to turn off or silence your cell phones. please welcome the senior vice president for academic affairs and provost of the university of southern california, michael quick. [applause] michael: i would just -- there we are. i would just scream but, great to have you all here. thank you for coming. i realize nobody knows what a provost is. that is fine. the joke is, i am the guy at the cemetery who mows the lawn. i have many, many people underneath me. none of them give a damn what i have to say. but it is great to have you here tonight. welcome to this vision and voices event. this is the 11th year that we have sponsor this event.
our arts and humanities initiative. what i love most about visions and voices is that it goes beyond that traditional definition of what arts and and to really talk about bigger issues. we certainly have one this evening. this year i was talking with those who run our visions and voices program to think of new ways to have conversations, and one of the things that i think this university does very well is to tackle what i call the wicked problems. these are the large problems of the day, problems that require convergence of disciplines to tackle and to approach these problems, everything from the arts through the medical sciences are needed to bring to bear the expertise to tackle these very hard problems.
the other thing that is interesting about wicked problems, i think, is that there is no perfect solution. these are problems that, at best, if you can get your head around it, you are going to get some solution but it is not going to be the perfect solution. certainly the issue of addiction , fits into that very well. i am a scientist by training, interestingn is an topic. the reason brains get addicted is because they tap into the very evolutionary mechanisms that allow us to learn. it is this interesting trade-off of learning that brings about the fact that we can become addicted to a number of different things. so in the know of itself, that is an interesting intellectual wicked problem. there is also a social wicked problem to it we think about opiate addiction, for example.
opiates were a profoundly important discovery in the medical sciences. it allowed us to provide analgesia during surgeries and and for pain, and yet again, it ends up being one of those situations that causes people to addicted, anddly opiate addiction in this country is rampant. how do you treat that? responsibilities of all parties to find a way forward? we thought that would be a terrific conversation piece, and it is great that i have the opportunity to welcome our panelists this evening to talk about this for the next two or three hours.
let me please introduce our panelists and have them come up. they come from very different backgrounds. we could have chosen a number of groups of people to talk about this issue but we found four engaging people who will lead us this evening. dana goldman is a faculty member here at usc. walk slower -- i am going to be talking for a while. he oversees our center for health policy and economics, one of the leading programs in the country. he is a nationally recognized health economist and advisor to the congressional budget office and they are doing just , tremendous work across the board on a number of health care issues. great to have dana here. welcome. sasha is a filmmaker and documentarian. he is a trojan, a graduate of our cinema school.
ba and an ma. he is best known for his film trilogy, "american addict." it examines the role of the pharmaceutical industry and americans' drug dependency. week,eened his film last and i hope you had a chance to see it. our third panelist is an executive producer and cowriter of "the big lie." he is very well known here in southern california. he is dr. gregory smith. gregory is a physician and hosts the radio show "truth, politics, and medicine." you may have heard that on kabc. dr. smith, welcome. thank you so much. and the person who is going to moderate all of this for us, professor valdez, from our
usc school of social work. he is going to help guide us through the evening. he will take your questions, as well. please, give it up to over moderator, professor valdez. to have you all. thank you all. well, welcome, everyone. i was given the task of moderating this evening, and hopefully we will have an interesting conversation on this very important issue, this wicked problem, as the provost identified it. i would like to make some comments to frame this. and address the changing nature of drug addiction in the united it to what itpare was, say, 50, 60 years ago. and i think that we are seeing a
really radical kind of change as we identify it as addiction, the change from the earlier period where the drugs that we were talking about were primarily street drugs. these were heroin, cocaine, meth, d, crack, marijuana -- certain extent, we can talk about if that is an addictive drug or not. and to a shift to what are now primarily when we talk about addiction, it is pharmaceutical drugs. vicodin, narco, xanax, and those drugs that are appearing. the difference is a big difference. the second thing is that drug users themselves are different. during this earlier period,
1960's, drug using populations were primarily urban populations, you know, artists and musicians and hipsters in the 1950's, william burroughs, those kinds of individuals. in the late 1960's, we had returning vietnam veterans that were part of a heroin epidemic that began in the united states, carried over into countercultural groups that were around. and of course, during this whole a few, middle 1950's to years ago, there were the marginalized black and latinos that were with the face of addiction. these were often times very young populations, although concentrated in again in cities, so it was a difference.
if we fast-forward to where we are today, the joint users that -- drug users we are talking about today are primarily white, middle and working class, living in rural and, for the most part, rust belt states, experiencing economic hardships. so if we look at a map on where the highest levels of opiate use and opiate overdoses are, we will see this area that was not familiar to us, right, and try to understand what is going on with this problem. i think the other issue is the drug market today is distinct in that, before it was an illegal market a market sustained by , international criminal enterprises that stretched
internationally across different countries, different sources. and now the major suppliers of the drugs that we are talking about our large pharmaceutical corporations, big pharma companies. so this is -- so addiction and america really has a very different form. right? and a very different face. i think this is what we want to get at today and try to understand what has happened and how we arrived here. so i hope we get to answer some of those questions. i am going to ask questions and see if i can get some discussion. and all that these men are very talkative and have a lot of ideas. i do not think this will be a big challenge. i would like to start with, can someone on the panel kind of give us an overview of the nature and the extent of
the prescription medication crisis that we are experiencing? opiates and others occurring in the u.s. >> i think the doctor and i can address that. what we are experiencing is that people have to understand is that prescription drug abuse is a somewhat new phenomenon. we had the ushering in of drugs -1980's,odin in the mid- and then in the 1990's, you saw oxycontin come onto the scene, and the big pharmaceutical companies were making huge money on these medications, and they were put out there because the world health organization and other organizations internationally said that we were under treating pain, that there were too many people in pain and the answer was more and more drugs. and when i was getting out of residency, i bought into this 100%. it is what i was taught. and the drugs that were long-acting were supposed to be safer. what happened was there was like
a full reign of writing these medications, and they were extremely profitable. so what you saw was this uptick of people being placed on opioids for all kinds of pain. we got into a problem because there was no education for the physicians for this, and they just started writing these medications. so you go to get a root canal 90 you get 90 norco or vicodin, and the problem is no one knows the exact timeframe, but it could be anywhere from days to weeks, depending on your genetics, that a person can become wildly addicted to those medications, and it is that fast. you can tell with a high degree of accuracy from a genetic standpoint if a person takes a medication, if they take the medication and can be addicted,
whereas another person can take the same vicodin or norco or oxy, and they get sick and throw it in the trash and never use it again. because no one knew that, these drugs were being written in high amounts. and all of a sudden, we get into this epidemic situation. so we look at the numbers, and it is in the film. 5% of the population of the world, but we are using 95% of the world's hydrocodone, which is norco, vicodin. 70% of all mobile yields -- opioids in the united states. we have an insatiable desire for medications. the pharmaceutical companies have been very happy to allow this to happen because it has been extremely profitable. this is how it started. we had a situation where we were told we are not treating chronic pain aggressively, so there was and push for medications,
it was ignoring all the other alternatives for treating pain and addiction that are natural, the list goes on and on, that were put out there as quackery when nothing could be further from the truth. you talk about this new documentary work. -- ins the association your film, you talk about the association, the fda, big pharma, physicians, the media -- how did they contribute to what dr. smith was saying about prescription use and everything that happened? >> interesting story. my background is i went to usc cinema school and i come from the narrative background so i am a writer/director. i was yet to do a documentary film. i always wanted to, but it needed to be a particular subject matter that was of interest to me.
by happenstance, i met greg him and, come on, 70% of americans are on drugs. everybody in this room knows somebody who has taken prescription medication, if you are not yourselves on something. we just are, we are a heavily medicated society. as a filmmaker, it is one thing to do a documentary about an issue that is important, and i look at several factors. interesting most was the cultural application to it. we, as americans, as a cultural phenomenon. we live a very fast-paced lifestyle. we are a first world technologically advanced nation that thinks that we can have some type of either technological or medical fix. that is just the way we are. me to thislly drew subject. i sort of put on my investigatory hat. it is different when you write a
narrative or you are directing a screenplay. you have the story there. it sort of goes in certain directions. when you are filming a documentary, you can go in any direction. you are trying to find some subjects for your film, and you are investigating at the same time. with the greg's medical background, my job was like, let's make this hyper political. in my background, i am sort of, especially when i make my films, i am very apolitical. i do not try to take any political platform or try to bring any partisanship to the film. i just want to take the film were the information led me. moderator: so we cannot blame any one political party for this? >> no. 2011, we started off with the bush administration, basically, and we followed
medicare part d, which was written by bush and it was , pretty much written by the pharmaceutical companies. so we went to washington, d.c., to the fda, and to these conduits and we started at the top, the executive branch, down through congress, down through the public. the fda, which was sort of the buffer zone between the public and the health regulations and , and what we found was astonishing. the da.nterviews with they were canceling at the last minute when they found out about the film. the head of the fda -- moderator: the fda never talked to you guys, right? >> we had access to the fda, which most people do not. it is a giant facility, a monstrous facility in washington, d.c. we flew all the way from los angeles and the head was
scheduled to speak with us, and she canceled at the last minute saying they had to address the united nations, and we said we will reschedule it for two days following that. oh, something else came out. it was always some big fancy political entity that was addressed. it was never like, you know, we are addressing the state of kentucky's health situation or something. it was like, the united nations per its so we waited and waited and they decline the interview, but they allowed us access inside, which we took the crew inside and got a lot of footage. yes, this is sort of a weg-winded answer, but interviewed congressman, presidential candidates, former secretary of housing that worked in the clinton administration, the bush administration, and we try to paint everything together -- the corporate aspects through
the lobbies, all the centers are being paid off. they have some vested interest in it. that is sort of where it went. i want to make one point about the partisanship aspect of it. to say we attacked bush, but we wanted to expose what was going on. so we had a lot of liberal democrats that were contacts in on, we showedht all the money republicans were getting, and republicans are criticizing, you know, me as being some rabid leftist. and the same happened with obama. it was a flipside. it is not about partisanship. it is not about democrats or republicans. it is that the issue at hand. until we start addressing that, i do not think we're going to -- moderator: one thing that comes out so strongly in the film is
how both republicans and democrats were taking large fees, donations, moneys. even in your film, which is a little shocking, that obama really was one of the major receivers of these dollars. right? >> number one. >> so, i mean, like i said, intraday's current political climate, which i don't what to get into, and everyone is what i am talking about. it is not about partisanship. the pharmaceutical industry is by far the biggest lobby in washington. they have all the money. nearly of all funding for two-thirds television shows and media comes from -- you see the commercials. for example, if we were to do this panel on fox news or cnn or one of the major platforms -- we have had some success with some , some, but if you go to far, all you have to do is make a phone call and say hey, , do you want your advertising money?
that is 70% of the revenue. what are they going to do? one of our featured guests in the film, he was a frequent contributor on fox and cnn years ago. he is gone. it is simple as that. they have all the money. they have endless supplies, so. >> feel like i have to. i think it is very useful to put some perspective on this problem. the provost said it well when he said there are no perfect solutions. you rewind maybe 30 years ago, and you think about a different problem, which is depression, for example. prior to the introduction of antidepressants, a lot of people were suffering the consequences of depression, and it was not widely diagnosed because why would you go to a doctor? there wasn't anything a doctor could do. they could just talk to you. what happened is we introduced
antidepressants, and there were a bunch of people who benefited from that. the problem, i think, it is a problem we have in america of excess. we used to not have enough calories, now we have too many. when you are a developed country and you price the way you are talking about is you end up with overuse and you end up with a worried about are pushing pills. and the question is why -- why is it that we create -- and i personally believe that all the health care actors respond to the incentives we put in front of them. for example, if you look at obstetricians who deliver babies, it has been shown that would you pay more for a c-section, they end up having doing more c-sections. everyone here may know some obstetrician and they all believe that they would never do
anything like that, but for whatever reason we know when you pay more for a surgical procedure, you see more of it. and drugs are the same way. when you pay more for drugs, you are going to see people pushing them, and you are going to see the types of things -- when you look at opioids in particular, there are some really that behaviors. but the point you made about pain, i think, is very important. let's think about what we're trying to achieve as a society. we are trying to actually do want to reduce people's pain. the problem is we are not paying for the reduction in pain, what we are paying for is the drugs regardless of whether they work , or not, regardless of the consequences of addiction. but there are models where we would eliminate the incentives for these companies to push drugs. for example, you could just pay someone -- say that we think this person, for example, this person just had surgery, and
they need two weeks of drugs. sum,re getting paid a lump and you and the doctor figure on how much you should take. at that point, the pharmaceutical company has no incentive to produce the drug. similarly we could pay for pain , reduction, so i think your point about -- why aren't we pursuing these other options -- and there is no profit. if i go over and make my mom feel better when she is in pain , no one pays me. that if they give her a pill, a lot of people are making some money. but it does not have to be that way. we could reward physicians for doing the patients or types of things that hopefully we will hear about. in other words we need to figure , it out to price so we level the playing field and create the incentives. moderator: let me ask you then. what was the motive behind doctors prescribing prescriptions? was it monetary?
or was it because they wanted to deal with pain? what was the motive behind doctors beginning to prescribe? >> i think there has been a huge misunderstanding. there is a perception that the doctors are making all of this money by giving up medications -- giving out medications, and it is simply not true. there is no financial reward. we need to take go back and look at why this has happened. when you look at who is funding medical schools, who is funding all the continuing medical education meetings, who is funding the market direct market allatients, it is pharmaceutical-based. what you are saying is true if we had a different solution. the problem is, the reason why it is not happening is because we are in a conventional medical system that is basically controlled by a money system so
unless we have a completely shift in our medical system, whether it is socialized medicine or other types of medical systems, this problem is not going to go away. put this in perspective, it takes about $700 million to $1 billion to get a drug to market. and these are for-profit companies. if a company spends that kind of money getting a drug to market, they are going to sell that at a high price. and medicare part d has us in a situation where they can name their own price. so when you look at this politically -- we talk about the films -- basically, obama, when he was running, said that what bush did was almost worthy of treason, but when he got into office, to get obamacare through he made a deal to make sure that , medicare part d stayed in place. that is the only way to pharmaceutical companies went
through with it. and there was a similar deal with the insurance companies. why would they happily go in it? why would they happily go in and ensure -- insure a bunch of sick people? the reason is because there were in thatthat were put most people don't know about that if the situation failed, the government would write checks. that is the reason why all these people are dropping out of exchanges. so our whole system is out of whack and it is not going to , change until there is a fundamental change in the way we do health care. there is no many and a lot of the things that actually work for people. and i have said that if we cannot the health care costs and half very quickly if you focused on making people healthier. we are symptom-based. we have bad foods, bad
environments, everybody gets sick and then they go to the doctor to get drugs. it is a vicious cycle. if we meet people healthier in the first place, there would be no reason to treat with such an extensive medical system. >> for example, there is a drug that is in development right now that will reduce diabetes, reduce cardiovascular disease may even prevent cancer. , it is called exercise. but the problem is, you know, and heas one physician said, you know this patient came , to see me, borderline hypertensive. he was prediabetic and more to morbidly obese, and the best thing i could do for this patient is take them for a walk, but i don't get paid for that. the question is, why not? i do think that i am a little bit more optimistic than you. we have done this on the physician side. it used to be physicians did
whatever they wanted, and then they got reimbursed for it. we are starting to say, you have to meet quality metrics and be providing good care and we will give you bonuses and incentives if you do that. we have been a little slower to do this on the pharma side. i do not know if it is lobbying, but given the antagonism towards this industry, it seems to me we have an opportunity to say we will reward you if you develop drugs that work and we only want you to use them on the patients for whom they are indicated and you are not going to be reimbursed for pushing your pills on off label uses where there is no evidence of effectiveness unless you can show it works. it seems to me it is the right time for that type of grand bar. -- grand bargain. moderator: can you talk about off labeling? that was something interesting for me when i saw your film. i did not realize that. >> i really want to say one
thing about what you said, because i think it is very important in terms of rewarding doctors for better outcomes. the administrative burden put on doctors offices and private practices is cost prohibitive to do some of those. that is one problem. as far as off labeling, off labeling is when you have a medication that has been fda-approved for some reason, but people notice that it works for other reasons. a perfect example of this is a drug for blood pressure. i remember when i was a student we could always tell who is on the drug because, women or men, they were hairy. so that became the drug for hair growth. there are all these other medications. that is using it off label.
they try to then get it fda-approved for that. it can be a good thing. it is a double-edged sword. if you see something that works for one use but they see it helps for neuropathic pain, but the problem is when the pharmaceutical companies see that, they say that if we can make doctors right it for this reason and that reason and that reason, we do not have to spend any more money. we can just open up new markets with the same drug. so where there is money, sometimes there is more corruption. this is where you see these huge lawsuits where they fine companies to billion dollars. what you do not know is they made $15 billion on the drugs they got fined on. i will take that any day, right? we have a fundamental issue in our system.
when you think these changes need to happen, who is going to change it? the pharmaceutical companies are paying $400 million to $700 million. the money is being changed that -- back and forth between the government and the fda. from theakes money and pharmaceutical companies every year, part of their budget. how are they going to regulate these companies? that is the part that needs to be discontinued, that there is no more funding by the fda, the fda receiving money from the pharmaceutical industry. >> i think there is also a fear factor. the pharmacological complex, sort of like the military-industrial complex, there is always some threat. the money is parallel. there is endless funding. there is always some threat at all times. we are never going to be safe. this is going to be forever, and people get scared. and the pharmacological complex
can do the same thing. swine flu, bird flu, always something, restless leg syndrome. we have impending factors looming. if the media hypes it enough and the pharmacological complex can market it and sell it, they make money. factor.the ultimate create a syndrome and solely p -- sell the pill for it. >> that has happened. pillcreate it and make the for it. and they tell you. can you sleep at night? are you ever hungry? [laughter] >> everyone has these symptoms. well, we have a drug for you. "oh, my god, better get some testosterone." they show that that kind of marketing is very effective.
moderator: we have had this epidemic for a number of years now and there has been responses, to be fair to the government, in terms of prescribing practices and monitoring systems. how is that working? is that having any impact? anybody want to -- >> i don't want to sound cynical. [laughter] >> i'm on the front lines of this. i've been on both sides of this , from the films and all that and seeing it in offices. but we have a prescription drug monitoring program. the government has tried to do things. the problem that the government does is they always try and limit access. and when you do that people that , want to do drugs are going to get their drugs. all you do is raise the black market or the illegal market of these drugs when you decrease it. and you also get people to actually need these medications caught in the net also. you have people suffering big-time right now because they have exhausted all things. that actually do need pills to
get by, to have any kind of life, but the coast the doctors are so afraid they will get prosecuted, get their license revoked, they will not write it. it is a problem. the issue here is better education and also exposing people to alternatives. and there are many. there are so many alternatives, no one should be in pain, really, and people do not even know about the multitude of things you can do to get out of pain because it is not profitable for the pharmaceutical industry. >> you are pointing to -- i agree completely. people will get their drugs and , and we saw some data from the schaeffer center today -- if you look at the deaths from heroin or opioid overdoses, it is up fourfold since 2010. this is a real problem. but also, if you look at the data, we asked the manufacturers to come up with versions of
their pills that could not be snorted and that would be extended release, and it has -- what it has done is pushed people underground in some ways, so i think it is very important to understand the visceral response, which i agree, is to limit supply, is not adequate. moderator: isn't that the other problem? those pills, because they are such large quantities, they are going onto the black market. now we have the added problem here, we have heroin epidemic returning back. >> it is cheaper. we have to remember prescription drug overdoses are more than heroin, cocaine, and methamphetamine combined in american culture. more prescription drug overdoses than heroin, methamphetamine, and cocaine combined. it is a generational thing. even our generation, i mean, growing up, if you look at our
youth today, it is much more prevalent for them because their parents are taking it or somebody is taking it. there are these cocktail drugs. the pharmaceutical lobby was very instrumental in brushing aside or even a the tobacco lobby, which is pretty much nonexistent. so now what we have, what was in the 1980's and 1990's, we had our famous hollywood and actresses smoking cigarettes. now you have nurse jackie taking pills, tony soprano, house taking prozac. believe it or not, this highly popular shows with highly popular american contemporary actors or stars, it does have an effect on our youth and not just the youth, the adult culture. it is a fact. in our films, we cover celebrity deaths. whitney houston, michael jackson, and prince. can you think of more prominent superstars than those three
names right there? and george michael, he was on antidepressants. and the media is very effective at saying he had cocaine and other drugs. i am not saying that was solely because, but it is usually -- dr. smith, you know, can attest to this, the cocktail of those drugs or alcohol that results in these deaths. >> you know, we tend to focus a lot in this country on treatment and little on prevention. what do you think of that? >> let me just say, this comes back to a broader point that i was just making about we pay -- this whole industry that we are talking about is rewarded for treating sickness. ok, no one is rewarded for keeping you healthy in the first place. so my exercise analogy is quite apt in that regard.
as you said we have medicalized , a lot of problems, but the reason is is that is how we get them covered by insurance, ironically. and we have made sure that insurance is quite generous. you go back to part b, for example, you know, insurance originally was designed to be something that would be there if, say, your house burned down, if something catastrophic happened. if we have 70% of the population taking prescription drugs, it is kind of like saying we will pay you for washing your windows. so we have completely changed the model where we have not -- where we are paying for treatment. we do not value prevention. so it is no wonder that no one is out there developing therapies, and i would argue, developing therapies that can keep people in good health. there is no incentive to do that right now.
the playing field is not level. only like 10% or 15% of people who take these prescription pills actually become addicted, so it is not like everybody is being addicted with these drugs. in fact, we talk about people in other societies, like canada and great britain, also have large prescriptions in opiates and don't have the same problems we have here. >> it is more than addiction. there is a health cost to taking medications at all, so look at some statistics that are disturbing. the united states spends about 17% of their gross domestic on product on health care. closest athe next about 7% at yet, we consistently, and not just
recently, but for the last 12, 15 years rank amongst civilized , countries or industrialized countries, i should say, last or dead last in every major health care indicator. including things like women that die giving birth to their children, length of life. the list goes on and on. we throw so much money after this, and that is why so many people are on medication. it is not just being addicted to opioids. i personally think the psychotropic drugs are a bigger problem than the opioids because of what they do to bring chemistry. you see people that kill themselves or other people or both when they are on psychotropics are trying to come off. it happens over and over again. i have a lot of information i cannot say publicly on different celebrities and things that i have been told about. i see different celebrities die, and sometimes i know what happened that was not reported. i can tell you with a high
degree of accuracy that the vast majority of celebrities you heard about that have died in the last seven to 10 years, it has been directly related to these medications. you do not have to be addicted. when you start looking at how you define addiction, there is a lot of different ways to look at then to just say they are opioids and you get the traditional sweats and withdrawal symptoms. people are on sleeping pills, anxiety pills, pain pills, and when you mix these altogether, that is where you get people having a deadly problem. they have organ issues. last thing i will say is that people have heard that you get kidney and liver issues. but people know that there are studies showing because we are getting more and more data out there, that you can get primary depression, people dropping that of heart disease for no other factor than they have been on
other medications. it goes way beyond us being addicted. it is the fact that we are all taking so many drugs cumulatively that is the problem. >> you have all seen these commercials. may cause heart attack, death, stroke. we're the only country in the world -- it used to be as and new zealand -- that allowed direct consumer advertising for the pharmaceutical companies that could directly go to the advertisers. new zealand did allow it, but i think as recently as maybe a year or two ago, they stopped. new zealand's population is 2, 3 million. we are the only ones that allowed direct consumer advertising. look at the prevalence of these commercials during any prime time tv show, sporting event, when watching a football game -- low testosterone, you know. soap operas, it is depression. tangled web that works to reinforce each other.
>> i will say that it is very helpful though. my son went to a dodgers game at 10 years old, and he went to -- i went to the bathroom for the second time, and he >> i want to say one thing that is positive because i'm not trying to be -- the united states is a great medical system for acute care. if you get shot, you know what i mean? this is a great place for thomas -- for trauma surgery. if you get broken bones. we suck at chronic disease. that is a problem. chronic disease is very profitable. if you get sick and do not die, you come every month to get your prescription. that is our problem, not the acute -- we are great at acute. all the innovation, we are great at that stuff. >> there are some people who will argue, on this topic, that it is not necessarily the chemical components of the drugs, right, that are causing this addiction and problems, but
rather people that feel more depressed and disconnected that really causes them to turn to these kinds of drugs. >> i cannot agree to that one. knowing the chemistry like i do, these medications and what they do in the body, there is no doubt that there are people that fall into that category. what is missing from all the data that is older than a year or two from right now is the genetic component. that is something that was missing. if people get genetic testing, you can all get it done. you can see with 97% accuracy, you can take vicodin, but you can take this one, but you cannot take this other one. this one can make you sick. there are people that from a genetic standpoint, you get them a drug and kabam! when i was in high school, people were doing different medications, different drugs,
and 10 years later, people got their life together, and the other ones were heroin addicts. why? >> from a sociological perspective, we can look at the distribution of heroin overdoses, right, or opiate overdoses, and it is clearly in particular states, particular regions. allwe say they are genetically disposed to these drugs, or are there other factors connected to this addiction? >> you are correct. when you see high unemployment rates and things of these nature, there is no doubt. people want to get out of their normal situation, and there's no doubt there is a factor to that, but i want to emphasize that what is never brought up is a genetic component. your dad, granddad were all alcoholics, and you are, it is no surprise. we can show what people can be predisposed to and not.
the reason pharmaceutical companies do not like genetic testing because they wanted to try this pill to see if it works by the time you find one that works, think how many you have already been prescribed. they do not like that. it limits their production capacity so to speak. that is a huge factor in that. >> let's talk in the next few minutes i'm going to take the , questions from the audience in about 10 minutes. so if we turn our attention to toaway from the consequences the solutions of this problem, knowing everything you do about prescriptions in this crisis, what would you say is the first step or short-term that can solve this problem? i guess we can think about a long-term as well. what are some of your thoughts? [laughter] >> i don't want to take too long. >> well, i just think one easy solution here is to start. take the example that just came up, which is that there is no
incentive right now to target your drugs to a particular person for whom it works, because it limits your market size. if we paid for value, right away, and we said, if the patient does not respond to your medication, you do not get paid. we live in a consumer society. health care is the only place where someone goes into the hospital, they come out and they don't get better, and we say ok, we will pay this huge bill. if my iphone does not work. i'm not paying. we need money back guarantees for our drugs. >> the one thing i will say -- and i agree with that. bring it back again to the problem. it prevents that. the problem is as long as you have a situation where the pharmaceutical company is paying the government, literally, how are they going to oversee them? that is the fundamental problem. >> there's some really powerful negotiators on the other side, so if you think about express
scripts, which it covers the drug benefits for about 80 million people, they are the ones who are negotiating prices, so we talk about they can set whatever price they want. they really can't. express scripts is five times as large as switzerland, so they are very powerful. they can negotiate some prices. we had to figure out how to give them the leverage to do that. i actually think liability shields, you know, if your insurance company does not cover something, then people will abouto we have to think malpractice reform in that situation. >> we have to make it completely
illegal for anyone who works for the fda to work for a pharmaceutical company. it is a backdoor. with finance, with everything, but when it is dealing with public health, i mean, we need to scrutinize that. somebody working for the fda has a backdoor in the pharmaceutical company, what do you think is going to happen? currently, it is a revolving door. they go work for the fda, work for a pharmaceutical company, work for the fda. this has to stop. >> they should all go work at goldman sachs. >> the other thing is education, educating people about prescription pills. quicking to end this real to take questions from the audience, but i understand from people in my office, i hope this is correct, that undergraduate
students at usc mandates alcohol and sex courses, but there is nothing on prescription medication. there is a real lack of knowledge about where we start taking these prescriptions. we do not really know where it is taking us. there needs to be much more education. >> i did not need a course in sex when i was in college. [laughter] >> seriously, i think education is important and also preventative. if the country got serious about preventing disease and problems, the health care system costs would plummet. i mean, look at some of the statistics. the vast majority of people in this country are deficient in vitamin d. the vast majority of people in this country are deficient in magnesium. when i say vast majority, i am talking 89%.
if magnesium deficiency can cause high blood pressure -- i give people a $10 bottle of magnesium lotion, and i can often get them off their antihypertensive medication and the bottle will last them for two months. people that are depressed, i put people on a drug which becomes dopamine, i elevate their serotonin/dopamine levels and get them off antidepressants because when you are taking antidepressant, it forces those neurotransmitters to stay in your brain to long, so that is why it is not natural. if you give people the building blocks to making their own -- it does not on everybody, but you can go to whole foods and get cheaper -- sprouts, go to sprouts and get a bottle of five htp, both for less than $35. last you a month. get people off antidepressants. >> so let us start taking
questions from the audience. this young man right here. >> sure. >> here is a mic. >> question to any of the panelists. dealing with what we are given, given a capitalist society, we are given the ability for pharmaceutical company to hire a wave of lobbyists. you have seen the report where they spent $9 million in lobbying fees to legislators dealing last decade, with the constraints of what we live with today, what would you recommend that realistically can get done, dealing with the constraints of the republican administration, which will be tough to get them in the regulation side of it. they are more free market, which
will accentuate everything we have been talking about. in dealing with the comment i want to throw in there that it has been about pharmaceuticals, sure ibad guy, i'm not agree with that because they are capitalists. it is up to the health care system to ensure we are taking people the right way. putting that comment aside, what are some realistic suggestions dealing with the constraints we have in the society we live in to make the changes that are necessary to drastically reduce the number of people dying from overdose? quickhave 2 responses. i actually agree with what you say. i tell people all the time they are a for-profit company trying to sell products, but if people are taking a more active role in their health care instead of
blindly doing whatever the doctor says, you will move the needle. a perfect example is organic food. 15 years ago, you could not find organic food unless he went to some guy who had a local health food store that had a tie-dye shirt on. you have over is everywhere. i wasn't smart and final the other day, and they have an organic section like you have to be kidding me. >> you're saying a solution potentially in the system we have is educating the public. >> they start asking, when you go to your doctor and say, my blood pressure is high, let me write you this, you say weight, is there anything i can do? >> with that suggestion, how would you implement it? where would the money come from to educate the public realistically? >> i would take 10% out of everyone's budget.
that is by the way about $40 billion. and i put that into prevention. i would put that into prevention. and i would figure out -- i do not know how to change behavior in this way. i do not think interdiction on supply, you know, is going to solve the problem. people want these drugs and they have illicit substitutes, but i know that we have no incentive to pay anyone to do research to get people off of these, so i would use that $40 billion for -- >> can we get another question here? >> how do we locate a doctor like dr. gregory? how do you find when somebody you know is addicted and they go continually to the same physician monthly because they only get a 30 day script, the doctor is making the money on them, how do you identify someone that will help them find something that will work? >> this is a huge problem.
i do integrative approaches to pain, medicine, addiction. it is rare, unfortunately. if it is hard to find someone -- i'm not saying it to toot my own horn. i do things differently. it is hard to find people that way. what you can do is just like when you get an estimate for something, if someone is going to get new windows in their house, they get estimates, but you go to the doctor, and they tell you to do whatever they say. go to a natural path. go to a nutritionist, chiropractors, acupuncturist. energy, reiki healers. energy healing helps. make your own educated decision. sometimes, the answer is integrative. maybe you take some medication. maybe you do this to fix the root cause. if a person is depressed, for example, you may need antidepressants at that moment, but 10 years later, 20 years later, -- fix the root cause.
that is by going to different -- >> i want to make one comment in reference to the gentleman saying that republicans are capitalist. i made that mistake, too. democrats are just as bad. they all take money. the sooner you identify that, personally, you are on the right course, because the obama received more money from pharmaceutical companies than any president in our history. it is just a chain effect. if you look at goldman sachs, the finance industry, medical, military, they are all same. we need to identify it is not just republicans or democrats. i'm a former democrat. [laughter] >> former? >> i'm not trying to get partisan here. we need to identify both of them as being culpable. i think that is a very important issue. a democrat taking office -- the affordable care act, obamacare, pharmaceutical companies named their price over the prescriptions, and we need -- it
is very important that we understand it is not a democrat issue. it is a money issue. >> the agenda is very similar. >> they may go up there, and you know, pretend like, you know, they are at each other's throats, but -- >> by jesse venture a says. it is like wwe. they all go rack and has beer together. it is similar to that. the agendas are very similar. in terms of democrat versus republican, at the end of the day, it is also getting done. >> thank you very much. extremely interesting, extremely informative. i'm in my early 70's. i get up a lot at night i need , to talk to you about my bladder. [laughter] >> i would like to pose the situation specifically about my wife. all right, my wife is in part with parkinson's and we went to a support group six month ago and while we were there, a fantastic lady from a place called usc came and offered a study.
in the study, they were looking for individuals who could expand their exercise and reduce their amount of medication. i said to the young lady, "how long did it take you to get this study funded?" she said two years to get it funded by the parkinson's association. i said to her, "suppose we reverse this and i asked if we could have a study to increase the amount of medication?" she said, i will have a check tomorrow. that is just the comment she made. i would like you to comment on that scenario, situation about my wife. >> is what i have been saying. the playing field is tilted in the wrong direction. we just have not solved that. -- we just -- we just have not solved that. it can be solved. assuming there is the political will to do it. >> yes, right here. >> this question is taking it down to the micro level, again.
i signed up to come see this talk about three months ago because i'm very interested in the topic. i am also a parent. i never would have imagined that today i would be moving my son out of the dorm because he is on -- he is onset opiate addicted. i'm very interested in the risk factors that may point in the direction of addiction. where on earth do we get this genetic test? i could have used it eight months ago before his tumor surgery. today, we are dealing with probably an addictive situation with opiates. >> that is a serious thing. there are several companies. the company that i like in proov company, i
have some affiliation working with them. i have been working with genetic parts for about 10 years. that's before anyone was talking about it. it is not a crystal ball, but it does help. young people right now are under unbelievable stress. i think way more than the other generation, because of so many things that are going on in our society. one of the things that you see is boredom and stress are two of the major things that move people to use a substance and the stress of getting good grades the stress of trying to , achieve, it is a lot. what happens is that a person is looking for a leg up, maybe a medication like adderall. similar things that people stay in college to stay awake.
to get smarter take -- it is natural. as it makes your brain pop. [laughter] >> boredom and stress. some of the things you see is when young people are under those conditions, what do they do? they look for medications that can help them cope. at the end of the day, all these medications are a way for people try and escape. so again education is one thing. , a lot of people, if they watch films, and there's other films they can watch, and see that when you are 18, 19 years old, you feel invincible, but when you start to find out that people are dying every 13 to 19 minutes, people on prescription drugs. when we picketed the fda, we had the men in black calling us from the fda. there were so many people under the age of 21, 22 that were dying, and these people came out came out with these huge
montages. it was heartbreaking. people dying from prescription drugs. it can happen. it is a new issue. our generation, marijuana, alcohol. can i ask an undergrad, someone who goes to parties? i have a question. incriminate yourself. [laughter] >> how prevalent is it to go to some type of party where, you know, a lot of beer, let's say marijuana, people are pushing pills or people are on some type of medication, or you know, is it commonplace at parties? answer freely. >> yes. >> is it common for people to say i need a norco or something, who has got it? think about this. we never did this. i'm 43 years old. this is something new that is not addressed. we have the marijuana, cocaine, but it is his cocktail of so many types of medication. i don't think people are addressing this. do people realize as parents that children, youth of today, are going to parties and there
is an assortment of cocktail drugs being given along with the alcohol. this is very, very new. >> the perception is is that these drugs are safer. everyone knew this was illegal, that is illegal, but because it comes in a pill form from a pharmacy, prescription -- but what you don't understand is in a laboratory, they are taking nature and putting it on steroids, literally. it is easier to get people off of heroin than oxycontin, much easier, because those molecules in oxycontin are really designed to hold on to the receptors. heroin is natural for the most part. >> heroin has been around for so long that they have been able to manage heroine. you have heroin addicts that live 50, 60, 70 years. the problem with the opiates we have now is that there is no understanding of them, right? [crosstalk]
>> since you honestly answered the question. [laughter] >> i guess anyone can respd to this, but using the tobacco industry, like falling out of power in the past, and not having as much of an influence over government, do you think something similar as possible with the pharmaceutical industry? do you think it is related to education, as you were talking about before? it is more on the individual, but do you think it applies to the greater national level and i guess that certain level of government? >> tobacco kills hundreds of thousands of people a year, and it is still legal, so i'm not sure that they don't have any -- i think the people most addicted to tobacco is the legislature to -- who get the revenues from the taxes. the premise there, i'm not sure entirely correct, but i will
say, again, the pharmaceuticals -- my worry as an economist is we have some conditions in the united states that are also epidemic like alzheimer's. i want to make sure we do something to reduce the incentives for pushing pills, in one population, but making sure we preserve them for innovation in areas that we really have a need. perfecthere are no solutions. why are people looking at alzheimer's? it is american disease and they think they are going to get paid big bucks if they come up with something. malaria kills one million people per year. no one is looking. it took bill gates before we came up with an antimalarial. how do we preserve the
incentives to innovate, and at the same time deal with the excesses that emerge as a result of our system? >> even with other drugs besides pharmaceuticals, you know, marijuana, cocaine, only 10% or 15% of people actually get addicted to those drugs, so it is a question of focusing on that 10% or 15%. i think we have time for maybe two more questions. >> one right here. >> this side? all right. >> i wanted to go back to your question about usc and other colleges having alcohol courses and sex education as a precursor to start school. how long did those, you know, classes take to actually set into a curriculum? how long do you think it would take them to do that for prescription drugs?
>> i think it could happen right away. i do not see why not. our provost could dictate that could have those classes. , it is a wicked problem. because of student government, there is a different mechanism to which we can do that. >> it comes to the individual as well. this generation, look at the pressure put on you. with technology doubling every two years. our lifestyle is so fast, everything is so quick. actually if you watch the big , lie, american addict 2, i start with a quote from huxley's "brave new world." i don't know if you have ever read that, it is one of my favorites. it is a dystopic portrayal of the future where there is a pill for everything. everything is, you know, the consumer or the citizen sort of
complacent within this manufactured reality. you know, all i wanted to do was give someone a philosophical approach to life. i think it is important to have your individual philosophy to learn who you are. collectivism is good, but you have to understand ourselves and take responsibility for ourselves. >> one more question. right here. go ahead, sir. >> hello. you mentioned natural alternatives to taking pain medication. could you mention those, please. >> there's many. one thing i will say. i will answer your question about what could bring the pharmaceutical companies down to what happened with tobacco. one word. cannabis. if you look at research done on
cannabis, mainly in israel, because it is illegal here, it treats a variety of disorders , including pain. when you look at the spice tumeric. in defense of the pharmaceutical companies, if your leg is broken , you want morphine. the natural stuff doesn't work the speed of a drug. that's why i am not saying drugs are all bad. it is the over use and abuse that is bad. people get an injury, get put on one of these medications and it should only be for a week or two, and five years later, they are still taking a norco for their knee or their back. there's a ton of different things that can help. it is hard to patent it because there is not much money. there's a device called nexflin. that helps with chronic pain and
insomnia. there is device that you can get on your years that you can get for $100 that helps you sleep like a baby. people have never even heard of this stuff because it is not on tv. so that is a long-winded answer to that one. >> all right, so listen, i think our time is up. i would like to thank our speakers, and you for being here. we will have lunch afterwards. [applause] >> carry on the conversation. [applause] >> all right. [no audio] [indistinct conversation]